Provider Demographics
NPI:1215355482
Name:HUSTON, REBECCA KANADY (LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KANADY
Last Name:HUSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 CAMPDEN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4835
Mailing Address - Country:US
Mailing Address - Phone:512-799-0402
Mailing Address - Fax:
Practice Address - Street 1:2331 CAMPDEN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4835
Practice Address - Country:US
Practice Address - Phone:512-799-0402
Practice Address - Fax:512-392-2567
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67458101YP2500X
MDLC5615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358616601Medicaid